Illinois Healthcare and Family ServicesIllinois Department of Human Services

04/22/15

Policy Memo

Summary

  • When a SNAP redetermination is due, complete the medical redetermination along with the SNAP redetermination.
  • A Renewal of medical eligibility may be completed when processing a SNAP rede using the following rede forms:
    • Form 1893, SNAP Redetermination Application
    • Form 4893, Your SNAP Benefits Are Ending
    • From 4765/4764, Redetermination Application
  • Form 4765B, Attachment to Application, must be completed when a medical rede is processed with a SNAP rede. This form may be completed by the caseworker when a phone interview is conducted. 
  • Renewals for Family Health Plans and ACA Adult cases require a Modified Adjusted Gross Income (MAGI) calculation.
  • MAGI renewals will be processed in ACM until the Integrated Eligibility System (IES) is ready for renewals and other case maintenance activities.
  • When a SNAP redetermination is due and a medical redetermination on the FHP is completed along with the SNAP rede and the case is determined eligible for medical, process the medical rede along with the SNAP rede. 
  • When a SNAP rede is due and a medical rede on the FHP case is completed along with the SNAP rede and the case is determined ineligible for medical, delete the parent (s) from the medical case and authorize continuous medical for the children only. Do not process the medical rede. 
  • The medical rede must be completed when adding SNAP to a existing medical case.  For 94/96 case, the applicant completes Form 683, Application for the Supplemental Nutrition Assistance Program (SNAP) and Form 4765B, Attachment to Application.
  • Use relationship rules, under MAGI budgeting, when Form 4765B is mailed to the customer and the customer fails to return the form within 10 calendar days.
  • A Smart Forms MAGI Calculator must be used to create the Eligibility Determination Group (EDG) and determine whose income to count for a MAGI renewal.
  • Complete one MAGI budget for each EDG.  A MAGI budget is not required for each individual household member if they are all in the same EDG. 
  • Review the Modified Adjusted Gross Income (MAGI) Budgeting for Medical policy memorandum dated 9/26/13 as well as training materials for the MAGI budget methodology.
  • Review the The New ACA Adult Group policy memorandum dated 05/07/14.
  • Use Non-MAGI budgeting when processing a medical redetermination for Aged, Blind or Disabled (AABD), Long Term Care (AABD), Health Benefits for Workers with Disabilities (HBWD), Medicare Saving Program (MSP)(QMB, SLIB, QI-1).
  • Individuals who are Former Foster Care are eligible for medical coverage. There is no income or resource test for Former Foster Care. Review the Foster Care Medical Benefits policy memorandum dated 10/03/13.
  • The income standard for AABD medical, LTC (AABD), HBWD and MSP is based on family size which includes the spouse and may include dependent children under the age of 18. The income standard may also include other persons living in the home for whom the parent (s) is responsible. See PM-15-06-02-c.
  • For simplified processing review Simplified Processing for Determining income and Resource Eligibility for Medical Benefits manual release dated 12/08/14.
  • For AABD medical, resources are considered verified if the person receives SSI. Do not request verification of resources for persons receiving SSI when completing an AABD redetermination with SNAP.
  • For AABD medical, declaration of resources is required for persons with income (excluding SSI) at or below 100% Federal Poverty Level.  Client must complete and sign HFS 2378DR (pdf), Declaration of Resource Information, when completing a medical rede with SNAP. Resources must be verified if declared resources are over the resource standard ($2,000 for 1 person, $3,000 for a couple).
  • For AABD medical, verification of resources is required for persons with income over 100% Federal Poverty Level. Client must complete and sign HFS 2378VR (pdf), Resource Information.
    1. Processing a FHP and ACA Adult Rede with a SNAP Rede
    2. SNAP Budgeting for MAGI Households
      1. Form 4765B, Attachment to Application
    3. Processing an AABD Medical Rede with a SNAP Rede
    4. LTC Cases (DoA, or Supportive Living Programs)
      1. Verify Income at Rede
      2. Verify Resources at Rede
    5. Request for Medical Benefits at Renewal
    6. Forms Referenced
  • When an AABD medical rede is completed with SNAP, complete the HFS 2378DR (pdf)or HFS 2378VR (pdf), as appropriate.
  • ACA Adults receiving LTC services, persons receiving Department On Aging (DoA) services and persons living in a Supportive Living Facility may receive SNAP benefits.
  • LTC may be authorized under ACA Adult and AABD medical. If LTC is authorized under ACA Adult apply MAGI budgeting and verify transfer of resources. For ACA Adults, refer to policy memo, The New ACA Adults Group, dated 05/07/14. If LTC is authorized under AABD use non-MAGI budgeting method.
  • For ACA Adult receiving Long Term Care, review resource transfers when processing a medical rede with a SNAP rede.  Customer must complete HFS 3654, Additional Financial Information for Long Term Care Applicants.
  • Transfer of resources reported on the 1229A must be verified for persons receiving DoA services or persons receiving SLF services when a medical redetermination is completed with a SNAP redetermination. 
  • HFS 2378DR or HFS 2378VR may be used at redetermination or when a change is reported that requires a review of resources for AABD.
  • Process a redetermination action when approving an existing case for LTC since all factors of eligibility are being reviewed.
  • Process the medical rede on all companion cases when the SNAP rede is processed.

Redeterminations for medical cases with SNAP are completed with the SNAP review. There are two different budgeting methods for determining medical eligibility.  Family Health Plan (FHP) and ACA Adult medical is determined using Modified Adjusted Gross Income (MAGI) budgeting methodology.  AABD eligibility uses non-MAGI budgeting methodology. 

Processing a FHP and ACA Adult Rede with a SNAP Rede

The MAGI Calculator is required for income determinations and renewals for Family Health Plans, ACA Adult and County Care households. 

The MAGI Calculator is a SmartForm developed to assist staff with the formation of the Eligibility Determination Group (EDG) and determine whose income to count for an individual's EDG. The MAGI Calculator will:

  • Determine the budget rule for the household member's EDG based on tax information;
  • Determine who is included in the household member's EDG based on the budget rule, relationship and age;
  • Determine whose income to include in the EDG;
  • Summarize the entry needed in the ACM actual screens; and
  • Prompt additional actions as needed when household members reach age 18, 19 or 65.

The MAGI Calculator will auto-populate various fields with all of the active members in the medical household. Staff will also enter the following information into the calculator:

  • Determine EDG for (person whose EDG is being determined from a drop down menu of household members);
  • Tax filer/tax dependent information;
  • Number of babies expected if an active household member has an Estimated Date of Delivery (EDD);
  • Note (area where staff can enter a note about the individual);
  • Earned income and frequency of pay; and
  • Unearned income and frequency of pay.

The MAGI Calculator is required for each MAGI budget. Many households will only require one MAGI calculation using the calculator because everyone has the same EDG. Document that each household member has the same EDG as all other household members. In this situation only one MAGI Calculator is needed.  The MAGI Calculator does not need to be completed separately for every household member.

Some households will require a MAGI Calculation using a calculator for each household member. If the 'EDG list' is not the same for all household members active on the case or if a household member's income is not counted toward the EDG of all household members, a separate MAGI calculation is required for each member. Although there may be other situations, some of these households are listed below:

  • Household contains a child whose caretaker relative is not their parent or stepparent;
  • Household contains both parents who are not married to one another;
  • A household member is being claimed as a tax dependent by a non-household member;
  • Parents are filing taxes separately; and
  • A tax dependent who is filing taxes on his/her own.

If each member in the household is eligible for the program in which they are enrolled (FamilyCare/All Kids Assist for example), they may all stay active on the same case.

Tip: Enter the highest amount of income ACM will accept as 'eligible' to avoid Priority Action List (PAL) codes C and U.

Example 1: The renewal household consists of Mr. and Mrs. A, their 10 year old child, Andy, and Mr. A's 7 year old nephew, Ben and his 17 year old niece, Mary. Mr. and Mrs. A receive FamilyCare and both children receive All Kids Assist. Mr. and Mrs. A are married filing a joint tax return and are claiming all of the children as tax dependents. Mary works, earning $700 per month and is expected to be required to file a tax return. The A family submitted their renewal form, and all income is satisfactorily verified. The MAGI calculator in Smart Forms confirms there is no change in the FamilyCare and All Kids eligibility for this household.

Individual Rule EDG EDG Size Countable Income
Mr. A. Tax Filer Mr. A, Mrs. A, Andrew, Ben, and Mary 5 $2,700
Mrs. A. Tax Filer Mr. A, Mrs. A, Andrew, Ben, and Mary 5 $2,700
Andy Tax Filer Mr. A, Mrs. A, Andrew, Ben, and Mary 5 $2,700
Ben Relationship Ben and Mary 2 $700
Mary Relationship Ben and Mary 2 $700

Legacy Budgeting

  • ACM will not accept more than one countable income code/standard size (Item 80 code 158) for the case.
  • The income standard for FamilyCare is 138% and the standard for All Kids Assist is 147%.
  • Individuals with different EDG sizes can be present on the same case, however, there is no way to show the EDG size for each individual in the legacy system.

Because ACM cannot show everyone's eligibility correctly, the MAGI calculator is the only document in the file that shows the eligibility for the household correctly. Using the highest income and EDG size ACM will accept ($2,700 for a HH size of 4 is less than the FamilyCare standard of $2,789), will lessen the possibility of receiving a Priority Action List (PAL) code C for unreported or underreported earnings..

Upload or print and file the MAGI calculator result(s) in the case file.

Please review the Modified Adjusted Gross Income (MAGI) Budgeting for Medical policy memorandum dated 9/26/13 as well as training materials for the MAGI budget methodology.

SNAP Budgeting for MAGI Households

Do not use the MAGI tax questions and budgeting method to determine eligibility for SNAP.

Countable income for MAGI medical may be different than countable income for SNAP. Use only the income and allowable expenses applicable to SNAP. Entering income and expenses in ACM Actual screens has not changed from current policy for SNAP. When income and expenses from SNAP differ from medical, an additional ACM Actual screen is required:

  • When completing the ACM Actual screens for MAGI medical, answer 'Y' to the Budget Cat and 'N' to the Budget FS fields; and
  • When completing the ACM Actual screens for SNAP, answer 'N' to the Budget Cat and 'Y' to the Budget FS fields.

Refer to policy memoranda, Renewal Processing & MAGI Calculator, dated 03/21/14 for additional policy guidance.

Form 4765B, Attachment to Application

The MAGI tax filer questions are added to the REDE notice. Customers must complete Form 4765B, Attachment to Application, when:

  • completing a SNAP rede on a 94/96 case; and 
  • adding SNAP to 94/96 case using Form 683, Application for the Supplemental Nutrition Assistance Program (SNAP).

Use relationship rules, under MAGI budgeting, when Form 4765B is issued and the customer fails to return the form.

The MAGI questions are not applicable to AABD medical, TANF, SNAP customers.

Example 2: Mrs. Jones receives FHP medical and SNAP benefits.  Ms. Jones is due for a SNAP redetermination in March.  Form 4765 and Form 4765B is mailed to Mrs. Jones.  She returned both forms to the FCRC. The caseworker will use Form 4765B to determined tax filer status for medical eligibility. Case is reviewed and is determined eligible for medical.  Process the medical rede along with the SNAP rede.

Example 3:  Mr. Smith receives FHP medical and SNAP benefits.  Mr. Smith is due for a SNAP rede in March. Form 4765 and Form 4765B is mailed to Mr. Smith.  Mr. Smith returned Form 4765 but failed to return Form 4765B.  Caseworker will use relationship rules under MAGI to determine medical eligibility. Case is reviewed and is determined eligible for medical. Process the medical rede along with the SNAP rede. 

Example 4:   Mr. Adams receives FHP medical and SNAP benefits.  Mr. Adams is due for a SNAP rede in March.  Form 4765 and Form 4765B is completed by the customer.  Case is determined ineligible for medical benefits.  Mr. Adam's medical rede is not due until August.  Process the SNAP rede only.  Do not process the medical rede.  Delete the parent (s) from the FHP case and authorize continuous medical eligibility for the children.  See PM 18-05-01

Example 5: Ms. Allen currently receives FHP medical.  She completes Form 683, Application for the Supplemental Nutrition Assistance Program (SNAP) and Form 4765B. Case remains eligible for medical.  The FCRC must process the medical rede and SNAP rede at the same time.

Example 6: Ms. Brown receives FHP medical and SNAP. She receives Form 4893, and calls into the Phone System Interview (PSI) to do her redetermination. The MAGI questions are answered during the interview. Caseworker will use the responses to determine tax filer status for medical eligibility. Case is reviewed and is determined eligible for medical. Process the medical rede along with the SNAP rede.

Example 7: Mr. Johnson receives ACA Adult and SNAP.  Mr. Johnson's SNAP rede is due.  SOLQ verified an increase in Mr. J's SSA disability benefits.  His income exceeds the ACA Adult standard. Determine eligibility for AABD since he is no longer eligible for ACA Adult. Customer must complete HFS 2378VR, request verification of reported resources and provide proof of medical bills. A new application is not required.  If eligible, approve AABD medical. 

Processing an AABD Medical Rede with a SNAP Rede

Use Non-MAGI budgeting when processing a redetermination of eligibility for Aged, Blind or Disabled (AABD) medical, Long Term Care (AABD), Health Benefits for Workers with Disabilities (HBWD), Medicare Saving Program (MSP)(QMB, SLIB, QI-1).  MAGI budgeting does not apply to these medical programs.

Example 8:  Mr. Thomas receives AABD medical and SNAP benefits.  Mr. Thomas's SNAP rede is due.  Mr. Thomas currently receives SSI.  The caseworker reviews eligibility for medical and SNAP based on the SNAP redetermination.  Since Mr. Thomas receives SSI, resources are considered verified for medical. Do not request verification of resources when completing the medical rede.

Example 9:  Ms. Johnson receives AABD medical and SNAP benefits.  Ms. Johnson's  SNAP rede is due.  She receives $950 monthly in Social Security disability benefits. Ms. J's income is under 100% FPL. For AABD medical, HFS 2378DR, Declaration of Resource Information,  must be completed regarding her resources along with the SNAP rede.  Her reported resources are at or below the resource standard so she qualifies for simplified processing. Client is not required to provide verification of her resources.  Process the AABD medical rede with the SNAP rede.

Example 10:  Mr. Woods receives AABD medical and SNAP benefits.  Mr. Wood's SNAP rede is due.  He receives $1000 monthly in Social Security disability benefits. Mr. W's verified income exceeds 100% FPL. For AABD medical, HFS 2378VR, Resource Information, must be completed and verification of resources is required before the medical rede can be processed with the SNAP rede.   

LTC Cases (DoA, or Supportive Living Programs)

Caseworkers must review transfer of resources on LTC cases when updating medical with a SNAP rede.  Caseworker may complete the resource section (including resource transfers) on Form 1229A, Nursing Home/Supportive Living Facility Redetermination Report Form during the telephone interview.  The caseworker must ask and document the customers responses on the form.  Completion of Form 4765B is not required for SLF cases with SNAP.

Example 11: Ms. Cooper receives AABD medical and SNAP.  Ms. Cooper is a resident of an SLF.  The SNAP redetermination is due. The SNAP redetermination is completed during a telephone interview.Since the caseworker is completing the medical rede with the SNAP rede the caseworker also completes the resource section of Form 1229A for medical. 

Verify Income at Rede

Review the case record and/or Summary of Case Information to determine what information needs verification. Always use electronic sources to verify proof of income when available. This includes SOLQ, The Work Number and AWVS. See WAG 19-02-03-b.

Verify Resources at Rede

Resources are not exempt for AABD medical.  Use simplified processing for determining ongoing financial eligibility for medical benefits in the following circumstances:

  • Accept receipt of Supplemental Security Income (SSI) as verification of financial eligibility for both income and resources for individuals who are receiving SSI. Do not request declaration or verification of resources.
  • Accept the individual's current written statement declaring that their resources are at or below the resource standard for the program, unless questionable, when their verified income is at or below 100% Federal Poverty Level (FPL). Client must complete and sign HFS 2378DR, Declaration of Resource Information, when completing a medical rede with SNAP. When the declared resources are over the resource standard ($2,000 for 1 person, $3,000 for a couple) send Form 1721 to request verification of resources.
  • Verify the individual's resources when their income is over 100% FPL. Client must complete and sign HFS 2378VR, Resource Information, and provide verification of resources when an AABD medical rede is completed with SNAP.

For simplified processing review Simplified Processing for Determining income and Resource Eligibility for Medical Benefits manual release dated 12/08/14.

Request for Medical Benefits at Renewal

Follow policy listed in PM 18-03-08 when someone requests to add a family member to medical benefits.

A tax filer or other adult who is included in the tax filer's tax household may apply and sign an application on behalf of:

  • their spouse who they live with, and
  • the individuals who are included in the tax filer's household, regardless of the tax filer's or tax dependents' age or relationship to the person who is signing the application.

Adult children of the customer may complete an application to request medical benefits for themselves.

Process the applications in IES. Eligible spouses and children under age 19 may be added for benefits if a signed Form 243 is received. MAGI rules apply to persons requesting to be added to an existing Family Health Plans, County Care or ACA Adult medical case.

Refer to manual release, Who Signs the Application for MAGI, dated 12/04/13. 

Forms Referenced

HFS 643G

HFS 1229

HFS 2378DR

HFS 2378VR

Form 243

Form 243C

Form 683

Form 1893

Form 4765/Form 4764

Form 4765B

Form 4893

[signed copy on file]

Gregory M. Bassi

Acting Secretary, Illinois Department of Human Services

Felicia F. Norwood

Director, Healthcare and Family Services